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NPI Code Detail

MEDICARE: TAKESHIA ENLOW OTR/L

MEDICARE:   TAKESHIA  ENLOW  OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational TherapistOTR2399AR

General Provider Information

NPI Number : 1720350945
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAKESHIA ENLOW OTR/L
Provider Business Mailing Address
First Line : 860 DEWAYNE LN
Second Line :
City : CONWAY
State : AR
Zip : 72034-6769
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3115 S BOWMAN RD
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72211-4623
Country : US
Telephone Number : 501-228-4848
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2012
Last Update Date : 02/03/2012

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Directions to “ TAKESHIA ENLOW OTR/L” Practice Location

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